Overview
Summary
Work History
Education
Skills
Certification
Accomplishments
Affiliations
Timeline
Generic

Jolene Roberts

Stanton,NE

Overview

12
12
years of professional experience
1
1
Certification

Summary

Professional with experience in care planning and case management, focusing on patient education and clinical assessment of health and social determinants of health (SDOH). Developed comprehensive care plans based on thorough assessments, ensuring regular monitoring of their effectiveness. Engaged in collaborative team meetings to address case management challenges, enhancing communication among staff members. Proficient in analyzing clinical data from diverse sources, including electronic health records and laboratory results, to inform decision-making processes.

Work History

Care Manager for OB, NICU and Pediatrics

Centene/Nebraska Total Care
Omaha, Nebraska
05.2018 - 06.2025
  • Educated family members about patient's condition, treatments and available resources.
  • Participated in team meetings with other staff members to discuss case management issues.
  • Developed care plans based on assessment findings; monitored effectiveness of plans regularly.

HEDIS Review Nurse at Nebraska Total Care

Aerotek
Omaha, Ne
12.2017 - 05.2018
  • Employed methods of identifying information, business and technical requirements to meet user complex and unique health information and technology needs.
  • Used advanced health informatics knowledge and judgment to promote colleague involvement in planning, decision-making and evaluating outcomes.
  • Integrated decision support, clinical pathways and best practices into health information technology to enhance delivery of care and workflows.
  • Implemented healthcare systems for patient status monitoring, quality tracking and home care management.

Medical Review Nurse

BCBS of Nebraska
Omaha, NE
09.2016 - 12.2017
  • Field incoming pre-authorization calls from providers and conduct timely medical reviews
  • Determination availability of benefits according to company contracts, endorsements and policies
  • Analyzed clinical data from a variety of sources including electronic health records, laboratory results and physician note

Associate Manager and Consulting

Lexicode
Lexington , SC
09.2015 - 01.2016
  • Ensured compliance with company regulations, laws, and safety standards.
  • Remote position providing HIM coding and consulting services to healthcare providers. Coding Compliance
  • DRG auditor reviewing commercial claims previously completed by coders, checking for accuracy with ICD 9 and 10 codes

Program Integrity Medical Review Nurse II

Strategic Health Solutions
Omaha, NE
07.2013 - 09.2015
  • Prepared detailed summaries outlining findings from investigations into suspicious activity for senior leadership review.
  • Collaborated with other members of the healthcare team to ensure appropriate utilization of services. Determine medical necessity
  • Perform analysis for adherence to appropriate regulations and determinations according to policy and procedures

Education

Associate of Science - Nursing

IWCC
Council Bluffs, IA
12-2005

Skills

  • Care planning
  • Patient education
  • Case management
  • Clinical assessment of health and SDOH

Certification

  • Certified Breastfeeding Educator

Accomplishments

Nominee for March of Dimes, received patient excellence award from Alegent Health

Affiliations

  • Previous volunteer for Assure Women’s Center teaching Breastfeeding classes for 9 years

Timeline

Care Manager for OB, NICU and Pediatrics

Centene/Nebraska Total Care
05.2018 - 06.2025

HEDIS Review Nurse at Nebraska Total Care

Aerotek
12.2017 - 05.2018

Medical Review Nurse

BCBS of Nebraska
09.2016 - 12.2017

Associate Manager and Consulting

Lexicode
09.2015 - 01.2016

Program Integrity Medical Review Nurse II

Strategic Health Solutions
07.2013 - 09.2015

Associate of Science - Nursing

IWCC

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